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ED Coding and Reimbursement Alert

READER QUESTIONS:

Use P Mod on Non-Compliant PQRI Scenarios

Published on Mon May 25, 2009

Question: A 68-year-old Medicare patient reports to the ED in cardiac distress. The physician performs CPR and then stabilizes the patient during a level-five E/M service; he diagnoses a diaphragmatic acute myocardial infarction (AMI). Notes indicate that the physician did not give the patient aspirin due to an allergy. Can we still report this encounter under the physician quality reporting initiative (PQRI)? New York Subscriber Answer: This visit meets the requirements for PQRI measure 28: -Aspirin at Arrival for Acute Myocardial Infarction (AMI).- You will, however, need to remember a P modifier to explain why the physician did not give the patient aspirin. On the claim, report the following: - 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and [...]
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